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Individual

CHERYL ANN TANASOVICH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
1300 S ELISEO DR, SUITE 207, GREENBRAE, CA 94904-2023
(415) 925-0550
(415) 925-9062
Mailing address
1300 S ELISEO DR, SUITE 207, GREENBRAE, CA 94904-2023
(415) 925-0550
(415) 925-9062

Taxonomy

Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
G53455
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0004133440
AETNA PROVIDER NUMBER
CA
01
00G534550
BLUE SHIELD PROV #
CA
01
00G534551
MEDI-CAL PROVIDER NUMBER
CA
01
070003525
RAILROAD MEDICARE PROV #
CA
01
931041613
TRICARE PROVIDER NUMBER
CA
Enumeration date
07/08/2006
Last updated
07/18/2007
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